By: Heather Rolland Bipolar disorder is a serious medical condition requiring treatment. Whether the best…
Suicide Risk and Bipolar Disorder
It is well established that a diagnosis of bipolar disorder increases the risk of suicide significantly. Beyond that, due to the vagaries of mental health diagnoses, it becomes difficult to tease out precisely what the relationship is, as many people carry more than one diagnosis simultaneously, or have been diagnosed depressed or schizophrenic at other times in their life while they may be diagnosed bipolar at the time of their suicide. Further, as bipolar disorder includes depressive phases, the statistics become even more blurry as to whether experiencing depressive phases increase risk, or if the separate and additional diagnosis of a major depressive disorder is necessary to increase risk. Recent studies have indicated that a diagnosis of bipolar disorder carries a higher suicide risk than a diagnosis of “unipolar” depression.
One significant increase in the risk factor for suicide is the absence of treatment. If a person with bipolar disorder is not currently in treatment (with a therapist or with a medical doctor), the risk of suicide increases.
Understanding the Risk Factors
Both men and women with bipolar disorder attempt suicide, although the statistics indicate that men will complete the act more often than women. According to the National Mental Health Association, men commit 75% of all suicides (regardless of diagnosis) while double the number of women make attempts. This is not a reason to downplay any attempt ever by anyone, male or female, but it is a statistic that should help caregivers and loved ones be aware of potential risks.
Additional risk factors for suicide include having a co-morbid substance abuse diagnosis. For a number of reasons, both having to do with the substances themselves (overdose risks, for example) and having to do with the effects of the substance (reduced inhibitions and increased depression) or having to do with the impact of substance abuse on lifestyle (legal problems, financial problems or relationship problems), the presence of substance abuse greatly increases suicide risk.
The presence of firearms in the home also increases suicide risk in those diagnosed with bipolar disease. This is an important consideration for caregivers and loved ones, given that locked gun cabinets may not be sufficient to keep a loved one safe. Have a plan in advance for any family member diagnosed with bipolar disorder who lives in a household where firearms are present. Don’t wait until there is a crisis to figure out how to keep your loved one safe.
How Suicide Can Manifest
Suicide is commonly associated with depression and the depressive phase of bipolar disorder. However, suicide continues to be a risk during manic phases, especially if grandiosity or other manic symptoms are coupled with psychotic symptoms. Suicides occur during both phases of the cycle, and while the thinking and behaviors that lead up to the attempt may be very different, the risk is still present.
Even if a person does not ever make an attempt or report suicidal thoughts, statistics indicate that at least 50% of people with bipolar disorder have suicidal thoughts. This means that confronting this problem should be an important part of treatment. If your mental health provider isn’t asking you or your loved one about suicide, bring it up. Share your thoughts, even if the idea of doing so is scary. Your safety, or that of your loved one’s is important enough to take the risk and talk openly about what is going on.
Having suicidal thoughts is not an automatic ticket to inpatient care, although in some cases it might be. But opening up about feeling like harming yourself is the beginning of a very important step in treatment in which you and your therapist or doctor can work on safety planning and real skill building to ensure that when you are feeling so low and desperate you have options and supports in place. Over time, the treatment will shift focus to helping you avoid reaching that place of desperation, and having skills to prevent feeling so low in the first place.